The Implementation of Code Blue Debriefing in the Critical Care Unit at Mercy Medical Center. Melissa Eberhard BSN, RN, CCRN

Transcription

1 The Implementation of Code Blue Debriefing in the Critical Care Unit at Mercy Medical Center Melissa Eberhard BSN, RN, CCRN

2 Objectives Define code blue debriefing Discuss development and implementation of code blue debriefing on unit Examine outcomes of code blue debriefing on both staff and patient Identify barriers of code blue debriefing implementation and discuss elimination interventions

3 The Life of a Nurse Repeated exposure to traumatic events Effects either not addressed or informally managed

4 Debriefing Formalized process Response to: Reduced resiliency Compassion fatigue & burn out Decreased retention Healthy work environment initiatives Poor patient outcomes

5 What is Code Blue Debriefing? Multidisciplinary communication technique Addresses emotional psychological, and spiritual needs of staff Identifies/remedies operational issues

6 Methods of Debriefing Hot vs. Cold Structured & Supported Debriefing Gather Analyze Summarize (GAS) American Heart Association recommended & taught

7 G.A.S. Method Gather Analyze Summarize

8 Tools

9 Commonalities Closed ended questions: Communication ACLS/PALS adherence Leadership Crowd Control Equipment functionality Outcome Opened ended questions Team performance Emotions

10 Mercy Medical Center Code Blue Debriefing Tool

11 Mercy Medical Center Code Blue Debriefing Tool

12 Mercy Medical Center Code Blue Debriefing Tool

13 How It s Done Post Code Pause Hot Debrief Tool Closed ended questions Open ended questions/conversation guided using G.A.S

14 Outcomes Staff will feel comfortable leading a post code blue debrief 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% How comfortable are you leading a post code debriefing? Pre-Education Post-Education

15 Why Should We Do One? Recommended by the American Heart Association and the European Resuscitation Council Addresses the needs of the staff, patient, and family

16 "So you are able to feel and you are also able to sense and give back. So the best way to cope with that in a healthy way, is you acknowledge your feelings when someone dies, you acknowledge the pain of that, but we don't own that. That's not my death, that's not my family, but I can acknowledge that this is a natural process, and this is what happens and I can acknowledge the pain that I bore witness to in caring for that family and caring for that patient. -Jonathan Bartels

17 Evidence The evidence shows that code blue debriefing causes: Increased feelings of support from peers and leaders Increased ability to pay homage/honor the patient Increased feelings of having enough time to regroup Decreased feelings of pressure to return to next assignment/task Decreased thoughts/feelings 24 hours after the event

18 Staff Survey Distributed to multidisciplinary staff in February Respondents, ~ 50% response rate

19 60.00% Do you feel supported by peers in your role as a code blue responder? 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Never Some of the Half of the Most of the Always Percent of Respondents

20 60.00% Do you feel supported by departmental leadership in your role as a code blue responder? 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Never Some of the Half of the Most of the Always Percent of Respondents

21 60.00% I have time to pay homage (honor) to the patient involved in a code blue 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Never Some of the Half of the Most of the Always Percent of Respondents

22 60.00% Do you feel pressure to quickly return to your next task or assignment? 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Never Some of the Half of the Most of the Always Percent of Respondents

23 60.00% 50.00% Do you feel you are given enough time to regroup before returning to your assignment? 40.00% 30.00% 20.00% 10.00% 0.00% Never Some of the Half of the Most of the Always Percent of Respondents

24 60.00% 50.00% Do you have thoughts or feelings associated with the event within 24 hours? 40.00% 30.00% 20.00% 10.00% 0.00% Never Some of the Half of the Most of the Always Percent of Respondents

25 Expected Outcomes Staff will report an increase in: Ability to honor the patient Having enough time to regroup before returning to work Feeling supported by peers and leadership Staff will report a decrease in: Thoughts/feelings associated with the event within 24 hour Feeling pressure to quickly return to assignment/task

26 Expected Outcomes Identify and address unplanned operational events Increase the amount of patients with return of spontaneous circulation (ROSC)

27 Mid-Implementation Data Measure Pre-Data (February 2017) Post Data 1 (October 2017) Variance (5 Point Likert Scale) Do you feel supported by peers in your role as a code blue responder? Do you feel supported by departmental leadership in your role as a code blue responder? I have time to honor the patient involved in a code blue After responding to a code blue, do you feel pressure to quickly return to your next task or assignment? After a code blue do you feel you are given enough time to regroup before returning to your assignment? Do you have thoughts or feelings associated with the event within 24 hours? 4.28 TBD +/ TBD +/ TBD +/ TBD +/ TBD +/ TBD +/-

28 Mid-Implementation Data Identified operational events Emergency Supplies Drug Availability Crowd Control

29 Barriers Confidentiality Staffing Inability Physical Space

30 Next Steps Quarterly Post Data Post Data 1(October 2017) Post Data 2 (January 2018) Post Data 3 (April 2018) Post Data 4 (July 2018) Implementation and education house wide

31 Questions?

32 References Chan PS. Public health burden of in-hospital cardiac arrest [June 19, 2015]. (IOM commissioned report). /media/files/report%20files/2015/gwtg.pdf Cole, F. L., Slocumb, E. M., & Mastey, J. M. (2001). A measure of critical care nurses post-code stress. Journal of Advanced Nursing,34(3), doi: /j x Copeland, D., & Liska, H. (2016). Implementation of a Post-Code Pause. Journal of Trauma Nursing,23(2), Couper, K., & Perkins, G. D. (2013). Debriefing after resuscitation. Current Opinion in Critical Care,19(3), CPR Buddy, INC.. (n.d.). CPR Buddy [Digital image]. Retrieved August 22, 2017, from Kessler, D. O., Cheng, A., & Mullan, P. C. (2015). Debriefing in the Emergency Department After Clinical Events: A Practical Guide. Annals of Emergency Medicine,65(6), Mullan, P. C., Wuestner, E., Kerr, T. D., Christopher, D. P., & Patel, B. (2013). Implementation of an In Situ Qualitative Debriefing Tool for Resuscitations. Resuscitation,84(7), doi: /j.resuscitation Onello, R., & Kuehn, M. (2017, June 23). Debriefing Strategies and Techniques for Reflective Learning. Lecture presented at National Nurse Education Summit. Meaningful-Learning.pdf Percarpio, K. B., Harris, F. S., Hartfield, B., Dunlap, B., Diekroger, W. E., Nichols, P. D.,... Neily, J. B. (2010). Code Debriefing from the Department of Veteran Affairs (VA) Medical Team Training Program Improves the Cardiopulmonary Resuscitation Process. The Joint Commission Journal on Quality and Patient Safety,36(9), Questions [Digital image]. (2017, August 18). Retrieved August 24, 2017, from Salas, E., Klein, C., King, H., Salisbury, M., Augenstein, J. S., Birnbach, D. J.,... Upshaw, C. (2008). Debriefing Medical Teams: 12 Evidence-Based Best Practices and Tips. The Joint Commission Journal on Quality and Patient Safety,34(9), Sawyer, T., Loren, D., & Halamek, L. P. (2016). Post-event debriefings during neonatal care: why are we not doing them, and how can we start? Journal of Perinatology,36(6), Sjöberg, F., Schönning, E., & Salzmann-Erikson, M. (2015). Nurses' experiences of performing cardiopulmonary resuscitation in intensive care units: a qualitative study. Journal of Clinical Nursing,24(17-18), Structured and Supported Debriefing (2017). American Heart Association. (n.d.). Retrieved from